Disaster management following explosion

Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.